• GWRRA Membership Application •
Member
Name: ______________________________________________
Last First
□
New □ Renew
Member No: ___________________
Co-Rider
Names:
__________________________________________________________________________________________________________
Mailing
Address: ________________________________________________________________
□
Telephone:
Home: ( ) ________________________________Work: ( ) ___________________________
E-Mail:_____________________
Gold Book™ Directory Information: A)
□ Pick-up Truck/Trailer B) □
Phone Calls Only C) □ Tent
Space D) □ Lodging
E)
□ Tools F) □
Tour Guide
□
Do not list me in the Gold Book
GWRRA
800-843-9460
(623)
581-2500
(623)
581-3844 Fax
www.gwrra.org
www.towbusters.com
Member Type (Select One)
Individual Membership
□
3 yrs $120 USD □ 2 yrs $85 USD
□ 1 yr $45 USD
Family Membership (2 or more
people in household)
□
3 yrs $150 USD □ 2 yrs $105
USD □ 1 yr $55 USD
Associate Individual*
□
3 yrs $135 USD □ 2 yrs $95 USD □
1 yr $50 USD
Associate Family*
□
3 yrs $165 USD □
2 yrs $115 USD □
1 yr $60 USD
Subscription Only (Wing World™
Magazine) o 1 yr $40
*The
Associate Membership is for those who wish to take advantage of
GWRRA
and its benefits and do not own a Gold Wing or Valkyrie.
□
Yes! I want Rescue Plus for just $25
per year.
(Non-Members
$50)
Your
GWRRA Membership includes Rescue emergency
roadside
assistance while driving any motorcycle. Rescue
Plus offers enhanced benefits
and covers all registered drivers
in
your household while driving or riding in any non-commercial
vehicle
or motorcycle. Rescue Plus also
covers your
motorcycle
trailer. Certain limitations and exclusions apply to
coverage.
All individuals must be registered with GWRRA to
receive
a membership card and coverage. Members of
GWRRA
must have a Family Membership to cover multiple
drivers.
□
Join Now Pay Later
Yes!
I want to begin receiving my Wing World™
right
away. Send me a bill. I understand that I
will be eligible
for full member benefits upon
payment
of my dues.
Payment Information
How did you hear about us? Name:
__Lance Kanserski___________ Member # _172763________ other:
____________________________
Make checks payable in US Funds to GWRRA. GWRRA
dues are not deductible as a
charitable
contribution for federal tax purposes.
Credit
Card Number/Expiration Date:____________________________________________
Cardholder’s Signature: _______________________________________________________ 6580/